Safety And Efficacy Of Steroid For The Treatment Of Idiopathic Sudden Sensorineural Hearing Loss：A Systematic Review And Meta-Analysis

ContextIdiopathic sudden sensorineural hearing loss is an otorhinolaryngologyemergency. The etiology and pathogenesis of idiopathic sudden sensorineural hearingloss remains obscure. Although steroids are commonly used to treat sudden hearingloss, the specific action of the steroids in the hearing apparatus is inconsistent.ObjectiveTo estimate the safety and efficacy of intratympanic steroid therapy and systemicsteroid therapy in the treatment of idiopathic sudden hearing loss.MethodsWe systematically searched the Cochrane Central Register of Controlled Trials(CENTRAL)，MEDLINE（PubMed），EMBASE and other databases followingsuggestions in the Cochrane Handbook for Systematic Reviews. We identified allrandomized controlled trials in which intratympanic steroid therapy or systemicsteroid therapy were evaluated in comparison with the other treatment or placebo.After filtering by criteria of Cochrane Collaboration, Then Meta-analysis wasperformed by RevMan5.2software.ResultsA total of19RCTs met the inclusion criteria for Meta-analysis. Theimprovement rate of systemic steroid therapy as primary treatment in patients withsudden deafness when compared with the patients received placebo: pooling results ofMeta-analysis showed no difference between the two groups.（RR=1.32[95%CI:0.72,2.44]，P=0.37）).There was no difference between subjects treated withsteroids compared with subjects treated with the other therapy（RR=0.98[95%CI:0.88, 1.09]，P=0.73）.Meta-analysis result implied that the total therapeutic effect(Hearingrecovery rate) of the intratympanic steroid group was significantly efficacy than theplacebo group(RR=4.80[95%CI:2.18,10.56]，P <0.0001）). While no difference ofimprovement rate occurred between intratympanic and systemic steroid therapy in theidiopathic sudden hearing loss patients.（RR=1.08[95%CI:0.86,1.35]，P=0.53)）.As compared with systemic steroid therapy, combination therapy(intratympanicsteroid therapy plus systemic steroid therapy) as primary treatment in patients withsudden deafness has a higher hearing recovery rate with the RR at1.45，but the95%confidence interval at1.00-2.10(P=0.05).Meta-analysis showed a better effect ofintratympanic steroid in idiopathic sudden sensorineural hearing loss as salvagetreatment than the control group[（RR=3.46[95%CI:2.27,5.28]，P <0.00001）].There are a wide range of side effects relating to systemic steroid use including moodchange, sleep, or appetite changes, increased thirst or dry mouth, elevated bloodglucose levels, and Weight change. The intratympanic group experienced adverseeffects typical of local injection, most often transient pain at the injection site andbrief caloric vertigo. Severe complications such as persistent tympanic membraneperforation and otitis media were rare.ConclusionThe efficacy of steroids in the treatment of idiopathic sudden sensorineuralhearing loss remains unclear. There was also no difference between systemic steroidsand the other therapy. For the primary treatment of idiopathic sudden hearing losspatients without contraindication to steroid，systemic steroid treatment still remainsthe first choice．But for the idiopathic sudden hearing loss patients who are do notrespond successfully to or are poorly tolerant of systemic steroids，intratympanicsteroid treatment may be an alternative treatment.